| Name: | EAST SIDE PRESCRIPTION CENTER, INC. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 14 Apr 1977 (48 years ago) |
| Date of Dissolution: | 11 Feb 2022 (3 years ago) |
| Date of Status Change: | 11 Feb 2022 (3 years ago) |
| Identification Number: | 000011290 |
| ZIP code: | 02906 |
| County: | Providence County |
| Principal Address: | 632 HOPE STREET, PROVIDENCE, RI, 02906, USA |
| Purpose: | DRUG STORE/LIQUOR |
| NAICS: | 445310 - Beer, Wine, and Liquor Stores |
| Fictitious names: |
East Side Wine and Spirits (trading name, 2016-04-28 - ) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194760470 | 2006-06-19 | 2009-01-20 | 632 HOPE ST, PROVIDENCE, RI, 029062658, US | 632 HOPE ST, PROVIDENCE, RI, 029062658, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 401-751-1430 |
| Fax | 4014548096 |
Authorized person
| Name | MR. RICHARD E BACKER |
| Role | PRES |
| Phone | 4017511430 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | ES04467 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 209 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | ES04467 |
| State | RI |
| Issuer | NCPDP |
| Number | 4102961 |
| Issuer | MEDICAID |
| Number | 9010209 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| SYDNEY I. RESNICK, ESQ. | Agent | 20 EAST BEL AIR ROAD, CRANSTON, RI, 02920, USA |
| Name | Role | Address |
|---|---|---|
| RICHARD BACKER | PRESIDENT | 40 HULING LANE EAST GREENWICH, RI 02818 USA |
| Name | Role | Address |
|---|---|---|
| CHARLOTTE BACKER | VICE PRESIDENT | 40 HULING LANE EAST GREENWICH, RI 02818 USA |
| Number | Name | File Date |
|---|---|---|
| 202210722950 | Articles of Dissolution | 2022-02-11 |
| 202210722310 | Annual Report | 2022-02-11 |
| 202210721980 | Reinstatement | 2022-02-11 |
| 202199623390 | Revocation Certificate For Failure to File the Annual Report for the Year | 2021-07-29 |
| 202196726760 | Revocation Notice For Failure to File An Annual Report | 2021-05-19 |
| 202031415000 | Annual Report | 2020-01-08 |
| 201984473420 | Annual Report | 2019-01-15 |
| 201861565170 | Annual Report | 2018-04-04 |
| 201730796430 | Annual Report | 2017-01-25 |
| 201696296630 | Annual Report | 2016-04-28 |
Date of last update: 05 Oct 2024
Sources: Rhode Island Department of State
